Teenage Pregnancy: building on success

1. Teenage Pregnancy: building on success Alison Hadley, Director, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire

2. The reasons for a teenage pregnancy strategy and progress to date

3. A reminder of the reasons for a Teenage Pregnancy Strategy • Poor outcomes for young parents and their children • The majority of under 18 conceptions are unplanned • A key public health issue of health and educational inequalities • Historically high rates compared with similar Western European countries and no sustained downward trend

4. Teenage Pregnancy Strategy:the goals Halve the under 18 conception rate from 1998-2010 to bring the rate in line with Western European countries Improve outcomes for teenage parents and their children, measured by increasing proportion of 16-19 mothers in education, employment or training 10 year strategies in each of the 150 local government areas with a local 2010 reduction target. If all areas met the target the 50% national goal would be achieved

5. England progress: 1998-2011 ▪ 34% reduction in under 18 conception rate ▪ >70,000 under 18 conceptions avoided if conception rate had remained the same as 1998 ▪ Lowest under 18 conception rate in England since 1969

6. Local Progress | 1998-2011 47% LAs have reduced rates more than the England average, 53% less. London has the largest reduction (44%). East and North West the lowest (30%)

7. Why the work needs to continue  We’re only two thirds of the way towards the original aim to bring rates down to levels experienced by young people in similar Western European countries  Outcomes for young parents and their children remain disproportionately poor

8. A continuing priority: the new policy context

9. A continuing priority: the national policy context ▪ A Framework for Sexual Health Improvement in England: - continue to reduce the rate of under 16 and under 18 conceptions one of four priorities Child Poverty Strategy: - under 18 conception rate a measure of national and local progress Raising the Participation Age: - from 2013 all 17 year olds in education, training or work based learning and all 18 year olds – until their 18th birthday - from 2015. Young parents included in RPA duty Children’s centres: - improving outcomes for young parents and their children is central to statutory guidance core purpose Public Health Outcomes Framework: - under 18 conception rate + other indicators disproportionately affecting teenage parents and their children

10. Public Health Outcomes Framework ▪ Under 18 conception rate ▪ Chlamydia diagnosis (15-24) Related indicators ▪ Children in poverty (63% higher risk) ▪ Child development at 2-2.5 years ▪ Rates of adolescents not in education, employment or training (NEET)(11% of all female NEETs are pregnant or teenage mothers) ▪ Proportion of people in long term unemployment(22% higher rates of poverty for teenage mothers x2 rate of unemployment for young fathers ▪ Infant mortality rate (60% higher risk) ▪ Incidence of low birth weight of term babies (25% higher risk) ▪ Maternal smoking prevalence (including during pregnancy) (x3 smoking rate) ▪ Breastfeeding initiation and prevalence at 6-8 weeks (1/3 lower rate) ▪ Hospital admissions caused by unintentional and deliberate injuries to under 5s ▪ Sexual violence

11. Sticking to the evidence

12. Sticking to the evidence Provision of high quality SRE (Kirby 2007) and improved use of contraception (Santelli 2008) are areas where strongest empirical evidence exists on impact on teenage pregnancy rates Universal and targeted. SRE and contraception provision for all, with more intensive support for young people at risk, combined with additional motivation to delay early pregnancy – ‘means and motivation’ No evidence that alternative approaches (e.g abstinence-only/benefit conditionality) are effective in reducing teenage pregnancy rates

13. Targeted support: identifying young people who need early help The strongest associated risk factors for pregnancy before 18 - Free school meals eligibility - Persistent school absence - Slower than expected progress between KS2 and KS3 (Years 7-9)* • (Teenage Pregnancy in England. DfE research report 2013)

14. Targeted support: identifying young people who need early help Other associated risk factors Low maternal educational aspirations of daughter at age 10 also a risk factor Looked after children and care leavers: 3 times rate of motherhood <18 Young people who have experienced sexual abuse and exploitation Young people with conduct disorders and mental health problems  Alcohol – association with under 18 conception and STIs, independent of deprivation

15. The critical importance of universalprevention The majority of girls who conceive under 18 do not have specific risk factors “A teenage pregnancy prevention strategy that seeks to reduce conception rates by a substantial margin cannot concentrate on high risk groups alone. Although certain girls are at much greater risk of conceiving and giving birth as teenagers than others, the majority of girls that conceive do not share these risk factors.” (Teenage Pregnancy in England. DfE research report 2013)

16. Sticking to the evidence: national policy support

17. Translating evidence into a ‘whole systems’ approach: ten factors for an effective local strategy

18. Next steps on improving sex and relationships education Sexual Health Improvement Framework: All young people receive appropriate information and education to enable them to make informed decisions. All children and young people receive good quality SRE at home, at school and in the community DfE PSHE Review: PSHE remains a necessary and important part of all pupils education All schools should teach PSHE All schools should deliver SRE in line with the statutory SRE guidance Ofsted: PSHE education makes ‘an outstanding and sustained contribution to pupils’ spiritual, moral, social and cultural development’but …Ofsted PSHE report finds SRE required improvement in >1/3 schools

19. Measuring the local gap between ambition and reality: some options A pupil audit of SRE in all schools, and PRUs, to identify strengths, weaknesses and common themes for improvement A parent audit in all schools to identify what information and support they need to talk to their children and work in partnership with the school An audit of teachers and school nurses to identify gaps in skills and confidence A LA wide survey of young people to capture views of 16+ to identify any gaps in knowledge and current sources of information and support Engage support of local councillors

20. Improving access to contraception and condoms Sexual Health Improvement Framework All young people have access to the full range of contraceptive methods and know where to access them Young people should be able to access condoms easily and feel confident about carrying and using them. Some questions to think about Do all young people in your area know about and have access to the full range of contraceptive methods + condoms Are the services systematically publicised and trusted by young people? How can GPs and practice nurses help?

21. Workforce training: making every contact count Sexual Health Improvement Framework Incorporate the prevention role of the wider non-health workforce into commissioning Join up sexual health services with other services and practitioners supporting young people: drugs and alcohol, mental health, sexual violence Some questions to think about: Is there multi-agency training reaching all practitioners, particularly those supporting more vulnerable young people? Do all services know about each other and how to support swift referrals for young people?

22. The pregnancy pathway and improving support for young parents

23. Mind the gap: is there a joined up pregnancy pathway in your area? Do all young people know about and have easy access tofree pregnancy testingand unbiased advice on pregnancy options If abortion is the chosen option, do all young people have: Swift referral to accessible NHS funded abortion service Pre-abortion: access to accurate, unbiased information and a trained counsellor if required, chlamydia screening and support with post abortion contraception Post abortion: access to trained counsellor if required, follow up support on contraception and sexual health

24. The importance of a care pathway for young parents: recommendations from serious case reviews “’In too many cases: there had been insufficient support for young parents‘ Young teenage parents need to be supported in an environment in which they feel comfortable and supported. Adult centred services may not achieve this without additional teenage focused services Both parents need to be supported. The father is as important as the mother and they need support to help them become good parents There should be a joined up (multi-agency) approach to teenage pregnancy and teenage parents with every agency understanding their role within it. Planned and coordinated transfer of care between midwifery services, health visitors, children’s centres and GPs is critical

25. Mind the gap: is there a joined up care pathway for young parents? If continuing the pregnancy is the chosen option Swift referral to antenatal booking + information to support healthy early pregnancy Sensitive but robust pre-birth assessment/CAF in maternity services to identify and address any problems early Tailored antenatal care and preparation for parenthood for teenage mothers and young fathers, including preparation for postnatal contraception Clear referral pathway between maternity services and dedicated support in children’s centres, HVs or specialist local service Co-ordinated support plan, tailored to individual need, with clear aim to achieve good outcomes on health, emotional wellbeing and education for both parents and their child – linked to LA wider programmes of RPA, skills and employability and regeneration

26. The added value of positive messages Messages for young people  Open and honest conversations about relationships and sexual health help young people make well informed choices Asking for contraception, sexual health advice or parenting support is the right and responsible thing to do No wrong door – all services and practitioners will try and help We value young people and and want to support everyone to develop and fulfil their ambitions

27. The added value of positive messages Keeping everyone on board in a changing landscape  Teenage pregnancy engagement days for all health and non-health practitioners working with young people 6 monthly update meetings – lunchtime or twilight Termly or 6 monthly newsletter Establishing and maintaining a local website with up to date information for young people, services and practitioners

28. Helpful resources A Framework for Sexual Health in England (DH) (2013) www.gov.uk/government/publications/a-framework-for-sexual-health-improvement-in-england Tackling teenage pregnancy: a briefing for councillors (2013) Relationships and sex education: a briefing for councillors (2013) http://www.local.gov.uk Not yet good enough: Ofsted report on PSHE (2013) http://www.ofsted.gov.uk/resources/not-yet-good-enough-personal-social-health-and-economic-education-schools Ages of Concern: lessons from serious case reviews (Ofsted) 2011 http://www.ofsted.gov.uk/resources/ages-of-concern-learning-lessons-serious-case-reviews Statutory Guidance on the Participation of Young People in Education, Employment or Training for LAs (2013) www.education.gov.uk/childrenandyoungpeople/youngpeople/participation/

29. For more information: Teenage Pregnancy Knowledge Exchange www.beds.ac.uk/knowledgeexchange alison.hadley@beds.ac.uk